The aim is to compare the pathogen detection performance of metagenomic next-generation sequencing (mNGS) and the culturing of percutaneous needle biopsy samples obtained from an individual with a suspected spinal infection.A retrospective study of 141 individuals with a suspected spinal infection was conducted, and mNGS was performed. The microbial spectra and detection performance between mNGS and the culturing-based method were compared, and the effects of antibiotic intervention and biopsy on the detection performance were assessed.The microorganisms isolated most commonly via the culturing-based method were Mycobacterium tuberculosis (n = 21), followed by Staphylococcus epidermidis (n = 13). The most common microorganisms detected via mNGS were Mycobacterium tuberculosis complex (MTBC) (n = 39), followed by Staphylococcus aureus (n = 15). The difference in the type of detected microorganisms between culturing and mNGS was observed only in Mycobacterium (P = 0.001). mNGS helped identify potential pathogens in 80.9% of cases, which was significantly higher than the positivity rate of 59.6% observed for the culturing-based method (P < 0.001). Moreover, mNGS had a sensitivity of 85.7% (95% CI, 78.4% to 91.3%), a specificity of 86.7% (95% CI, 59.5% to 98.3%), and sensitivity gains of 35% (85.7% vs. 50.8%; P < 0.001) during culturing, while no differences were observed in the specificity (86.7% vs. 93.3%; P = 0.543). In addition, antibiotic interventions significantly lowered the positivity rate of the culturing-based method (66.0% vs. 45.5%, P = 0.021) but had no effects on the results of mNGS (82.5% vs. 77.3%, P = 0.467).The use of mNGS could result in a higher detection rate compared to that observed with the culturing-based method in an individual with spinal infection and is particularly valuable for evaluating the effects of a mycobacterial infection or previous antibiotic intervention. 

/pdf/pathogen-detection-in-suspected-spinal-infection-metagenomic-c5qloe09.pdf

Pathogen detection in suspected spinal infection: metagenomic next-generation sequencing versus culture.

Imaging of Spondylodiscitis: An Update.

Spinal surgical procedures are becoming more common over the years, and imaging studies can be requested in the postoperative setting, such as a baseline study when implants are used, or when there is a new postoperative issue reported by the patient or even as routine surveillance. Therefore, it helps the surgeon in the appropriate management of cases. In this context, there is increasing importance of the radiologist in the adequate interpretation of postoperative images, as well as in the choice of the most appropriate modality for each case, especially among radiographs, computed tomography, magnetic resonance imaging and nuclear medicine. It is essential to be familiar with the main types of surgical techniques and imaging characteristics of each one, including the type and correct positioning of hardware involved, to differentiate normal and abnormal postoperative appearances. The purpose of this pictorial essay is to illustrate and discuss the more frequently used spine surgical interventions and their imaging characteristics, with an emphasis on classical decompression and fusion/stabilization procedures. KEY POINTS: Plain radiographs remain the main modality for baseline, dynamic evaluation, and follow-ups. CT is the method of choice for assessing bone fusion, hardware integrity and loosening. MRI should be used to evaluate bone marrow and soft tissue complications. Radiologists should be familiar with most performed spinal procedures in order to differentiate normal and abnormal. CRITICAL RELEVANCE STATEMENT: This article discusses the main surgical procedures involved in the spine, which can be didactically divided into decompression, stabilization-fusion, and miscellaneous, as well as the role of diagnostic imaging methods and their main findings in this context. 

/pdf/imaging-features-of-the-postoperative-spine-a-guide-to-basic-1e6pix2l.pdf

Imaging features of the postoperative spine: a guide to basic understanding of spine surgical procedures

OBJECTIVES
To examine physical therapist awareness and utilization of imaging referral privileges in the United States (US) and how it relates to direct access frequency.


METHODS
This study utilized survey data collected in 2020-2021 from US physical therapists. Subjects were asked about imaging referral jurisdictional authority in their state. Responses were analyzed for accuracy and compared to the level of jurisdictional authority and its impact on imaging referral. Analysis of imaging skills performance and imaging referral practices were compared to direct access frequency.


RESULTS
Only 42.0% of physical therapists practicing in states that allow imaging referral were aware of this privilege. Those practicing where imaging referral was allowed via state legislation were significantly more likely (p < 0.01) to be aware of this privilege (71.4%) compared to those granted by the state board (25.2%). Those aware of their imaging referral scope were more likely (p < 0.01) to practice imaging referral (44.5%) compared to those who were unaware (3.2%). Direct access frequency was positively associated with imaging skill performance and imaging referral practice (p < 0.01). Doctors of Physical Therapy, residency/fellowship-trained physical therapists, and board-certified physical therapists all reported practicing greater frequency of direct access (p < 0.01).


DISCUSSION/CONCLUSION
There is a striking lack of awareness of imaging privileges among physical therapists as influenced by the level of jurisdictional scope. These results suggest that the lack of awareness may have a dampening effect on diagnostic imaging referrals. The American Physical Therapy Association should consider engaging with state boards to raise imaging privilege awareness.

Physical therapist awareness of diagnostic imaging referral jurisdictional scope of practice: an observational study.

Neurological Emergencies in Geriatric Patients

Spine infection is both a clinical and diagnostic imaging challenge due to its relatively indolent and nonspecific clinical presentation. The diagnosis of spine infection is based upon a combination of clinical suspicion, imaging evaluation and, when possible, microbiologic confirmation performed from blood cultures or image-guided percutaneous or open spine biopsy. With respect to the imaging evaluation of suspected spine infection, MRI without and with contrast of the affected spine segment is the initial diagnostic test of choice. As noncontrast MRI of the spine is often used in the evaluation of back or neck pain not responding to conservative medical management, it may show findings that are suggestive of infection, hence this procedure may also be considered in the evaluation of suspected spine infection. Nuclear medicine studies, including skeletal scintigraphy, gallium scan, and FDG-PET/CT, may be helpful in equivocal or select cases. Similarly, radiography and CT may be appropriate for assessing overall spinal stability, spine alignment, osseous integrity and, when present, the status of spine instrumentation or spine implants. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

ACR Appropriateness Criteria® Suspected Spine Infection.

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ACR Appropriateness Criteria® Suspected Spine Infection.